Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Between 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>For 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.</jats:p></jats:sec>

Relative contribution of individual versus combined functional imaging studies in predicting seizure freedom in pediatric epilepsy surgery: an area under the curve analysis

“…Ultimately, the surgical result arises from the accuracy of defining the region of seizure onset or disrupting a critical network essential for the propagation of the seizure. 9,12 Neocortical epilepsy predominates in children and is difficult to localize. 7,8,12 The neocortex has robust projections, which make rapid and diffuse spread of epileptiform discharges common.…”

“…9,12 Neocortical epilepsy predominates in children and is difficult to localize. 7,8,12 The neocortex has robust projections, which make rapid and diffuse spread of epileptiform discharges common. The characteristic pathologic substrate is cortical dysplasia, which is often MRI occult.…”

“…The characteristic pathologic substrate is cortical dysplasia, which is often MRI occult. 1,7,10,12,19,24,33 Staged procedures in which a noninvasive evaluation (stage I) informs placement of intracranial electrodes (stage II) are common. Results of intracranial EEG findings from invasive electrodes allow confirmation of the precise region of ictal onset and propagation and the critical relationships with adjacent eloquent cortex.…”

Localization of Epileptic Seizure Focus by Computerized Analysis of fMRI Recordings

“…In appropriately selected patients, resection of this localized seizure origin can be curative. Despite the promise of this approach, surgical outcomes remain highly variable, even in optimal candidates (Cohen-Gadol et al, 2004;Cohen-Gadol et al, 2006;Hosoyama et al, 2017;Najm et al, 2013). Emerging studies motivated by these inconsistencies have demonstrated that pediatric focal epilepsy is not a localized disorder, but rather a disease of large-scale, distributed neural networks (Spencer, 2002).…”

Changes in the quality of life of children after surgical treatment for drug-resistant temporal lobe epilepsy

“…Оценка влияния операции на частоту приступов, по классификации J. Engel, продемонстрировала, что у 54,54% пациентов удалось добиться полного избавления от инвалидизирующих приступов в долгосрочной перспективе (от 3 до 7 лет). Эти данные совпадают с показателями благоприятных исходов, полученными другими исследователями [24,25].…”